四级预防方法的推动因素和障碍:现场专家的定性研究
Jessica Anneliese Otte1,2, Maria Llargués Pou3,4
1Department of Family Practice and Division of Palliative Care, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada Jessica.otte@ubc.ca.
BMJ open
|March 20, 2024
概括
四级预防 (P4) 保护患者免受不必要的医疗伤害. 专家们确定了患者与临床医生的关系,教育和系统设计是影响P4采用的关键因素,以改善医疗保健的可持续性.
科学领域:
- 医疗保健的可持续性 医疗保健的可持续性
- 医学伦理 医学伦理
- 卫生系统研究 卫生系统研究
背景情况:
- 人们越来越担心医疗保健的可持续性以及过度使用对患者和系统的负面影响.
- 四级预防 (P4) 旨在保护患者免受伤害超过益处的医疗干预,但其采用程度有限.
- 了解影响P4实施的因素对于优化医疗保健服务至关重要.
研究的目的:
- 确定在特定卫生系统内实施四级预防 (P4) 的推动因素和障碍.
- 探索现场专家和倡导者的观点,以促进P4的采用.
- 开发一个概念模型,将P4纳入医疗保健实践.
主要方法:
- 使用半结构面试的定性方法.
- 基于理论的方法进行主题分析和概念模型开发.
- 与加拿大不列颠哥伦比亚省12名现场专家进行的虚拟采访.
主要成果:
- 四个关键因素影响了P4的努力:患者与临床医生的关系,教育,卫生系统设计和影响者.
- 启用因素包括基于证据的医学,个人经验,公共运动和资源贫乏的背景经验.
- 障碍包括同行压力,宣传活动,认知偏见,文化因素,问题的复杂性和行业影响.
结论:
- 促进和阻碍P4与现有文献保持一致,但强调临床医生与患者关系的中心作用.
- 其他已识别的驱动因素显著影响了这一核心关系.
- 整合P4以减少过度测试,过度诊断和过度治疗需要系统和社会变化.
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